The usual age of onset of PCOS is between 18 and 24 and , although patients in their mid twenties may be wishing to conceive, younger women and teens may be struggling with oligo or amenorrhea (rare or absent periods), hirsutism (abnormal hair growth), and weight gain and not thinking at all about pregnancy.
At our New Jersey fertility center, North Hudson IVF, Dr. Jane Miller encourages young PCOS patients to adhere to simple behavioral and medical treatments in order to improve their health, lessen their chances of type II diabetes and the Metabolic syndrome, and to make it easier for them to become pregnant in the future – even if they require medical treatment to do so.
Weight loss is the most important “behavioral treatment”. With strict adherence to a well – balanced diet that is low in carbohydrates and saturated fats and that includes reasonable portion- control a lowering of the BMI (body mass index) to normal (18.5 to 24.9) may restore normal cyclic menses without the need for any medication. However, weight loss is not always easy to accomplish! Diet coupled with exercise (at least 30 minutes a day of physical activity) plus a lot of encouragement from family and the medical staff can often help the patient get the job done.
If diet and exercise aren’t enough to enable monthly periods, medications such at Metformin, an insulin sensitizer, and /or the oral contraceptive pill (if pregnancy is not desired) may be used. It is important that the uterus undergo a “withdrawal bleed” every 4 – 6 weeks to protect its lining from hyperplasia – an abnormal pre-cancerous cellular change. Provera (medroxyprogesterone acetate) tablets taken daily for 7 to 10 days each month may also be used to allow the uterine lining to shed. This treatment, however, although protecting the uterus, does not treat the underlying causes of PCOS.
In contrast, Metformin addresses the insulin resistance seen in PCOS and the oral contraceptive elevates SHBG – a hormone that binds excess circulating male hormones that contribute to the cycle irregularity and hirsutism. Aldactone, a potassium-sparing diuretic (“water pill”) may also be prescribed along with the oral contraceptive to treat unwanted facial and body hair.
For PCOS patients who desire pregnancy diet and exercise are encouraged along with medical treatment if the former alone fail to induce ovulation.
Oral tablets such as clomiphene citrate or tamoxifin may be tried for 1 or 2 months and, if no ongoing pregnancy ensues, injectable gonadotropins may be used to “cycle” patients for either IUI (intrauterine insemination) or IVF (in vitro fertilization). With both the oral and the injectable treatments ultrasound monitoring of follicle number and size and endometrial thickness and pattern are essential. PCOS patients tend to respond to treatment with many follicles, hence many eggs – sometimes in excess of 20. For these patients IVF with selective transfer of, at the most, 2 embryos is the safest way to avoid an unsafe pregnancy with high-order multiples.
At our New Jersey fertility center Dr. Jane Miller encourages her PCOS IVF patients to cryopreserve (freeze) any good- quality embryos in excess of the 1 or 2 transferred. These embryos will be available for future transfer if the patient so desires.